The clinical validity of the treatment satisfaction survey for intraocular pressure in ocular hypertensive and glaucoma patients

PURPOSE: To provide initial validation of the Treatment Satisfaction Survey-Intraocular Pressure (TSS-IOP) quality-of-life survey that analyses specific issues related to side effects, patient satisfaction, and compliance. METHODS: A prospective, observational cohort of 250 consecutive patients with primary open-angle glaucoma or ocular hypertension was administered the TSS-IOP survey. RESULTS: Factors that correlated with patient satisfaction included perceived effectiveness of the medicine (F=7.47, P<0.001), ocular irritation (F=6.06, P<0.001), conjunctival hyperaemia (F=4.40, P<0.001), ease of use (F=8.52, P<0.001), and convenience of use (F=6.90, P<0.001). Patient compliance, acceptance of their illness, and knowledge of glaucoma were also related to perceived effectiveness of the medicine (P<0.001), ease of use (P<0.05) and convenience (P<0.001). Physician ratings of patient pressure control, side effects, and instillation problems also were significantly correlated to patient satisfaction (R=0.13-0.26, P=0.05-0.001). The physician ratings of patient compliance, however, were not significantly related to any dimension of patient satisfaction (P>0.05). Among monotherapy prostaglandin treatments, latanoprost demonstrated statistically greater satisfaction than bimatoprost or travoprost regarding conjunctival hyperaemia (P<0.05) and eye irritation (P<0.01). CONCLUSIONS: This study provides initial evidence that patient satisfaction may be related to compliance, perceived effectiveness of treatment, adverse side effects, ease and convenience of use, acceptance of illness, and knowledge of glaucoma.     

What do people with glaucoma know about their condition? A comparative cross‐sectional incidence and prevalence survey

Purpose: To assess and compare glaucoma knowledge between patients with established glaucoma, newly diagnosed glaucoma and the general population. Methods: 208 glaucoma patients, 100 newly diagnosed glaucoma patients from three clinical centres and 100 controls from non‐ophthalmology outpatient clinics, were recruited and completed a validated self‐administered true/false questionnaire assessing glaucoma knowledge. Demographic data were also recorded. Glaucoma knowledge score, out of a maximum of 22, and odds ratios (OR) with 95% confidence intervals (CI) of survey characteristics associated with falling in the lowest quartile of the overall knowledge score was evaluated for each study group. Results: Established glaucoma patients had (median 17, interquartile range 15–19) marginally but significantly (P < 0.05) greater glaucoma knowledge scores than new patients (median 16, interquartile range 13–18). Both of these groups scored significantly better than the control population (median 13, interquartile range 10–14, P < 0.05). Significant misconceptions regarding glaucoma include: 80% of all participants thought that topical medications could not have systemic side‐effects, 48% of established glaucoma patients believed symptoms would warn them of disease progression. One‐third of new patients considered blindness to be a common outcome of having glaucoma. For established patients, factors associated (P < 0.05) with a lesser likelihood of scoring in the lowest quartile of the total score included having family (OR 0.33, 95% CI 0.11–0.98) or friends (OR 0.28, 95% CI 0.06–0.97) with glaucoma, being referred by an optometrist compared with general practitioner (OR 0.21, 95% CI 0.08–0.57), speaking English at home (OR 0.13, 95% CI 0.04–0.49) and being seen in the private health‐care sector (OR 0.13, 95% CI 0.04–0.42). Conclusion: Patients with established glaucoma have only slightly greater knowledge than newly diagnosed patients, with both patient groups harbouring significant misconceptions regarding glaucoma. Educational programmes and material should be tailored to address these misconceptions.     

Influence of Family History as a Risk Factor on Primary Angle Closure and Primary Open Angle Glaucoma in a Chinese population

Purpose: To identify the likelihood of family history as a risk factor for the presence and severity of primary angle closure (PAC) and primary open angle glaucoma (POAG) in a Chinese population.

Methods: All participants were asked to complete a questionnaire and undergo a comprehensive eye examination. Past history of hypertension, diabetes mellitus, hyperopia, high myopia, and family history of glaucoma were recorded. For those patients with a family history of glaucoma, the relationship between the patient and the affected relatives has been specified.

Results: A total of 332 PAC patients, 228 POAG patients and 193 controls were included. Of the 332 PAC patients, 83 (25.00%) had glaucoma family history. Characteristic-adjusted odds ratio (OR) of family history for PAC was 4.82 [95% confidence interval (CI): 2.08–11.19] and for severity of PAC was 1.61 (95% CI: 1.05–2.49). Among first-relatives only parents account for the family history rate of PAC [OR 8.76 (95% CI: 2.00–38.32)]. Of the 228 POAG patients, 49 (21.49%) had a family history of glaucoma. Odds ratio for POAG was 8.38 (95% CI: 3.33–21.07) and for severity of POAG was 1.81 (95% CI: 1.05–3.14). Unlike patients with PAC, only siblings and offspring account for the family history rate of POAG [OR 8.99 (95% CI: 2.38–33.99) and OR 19.23 (95% CI: 1.53–241.24) respectively].

Conclusion: Our study showed that a family history of glaucoma is associated with the presence and severity of PAC and POAG. This supports the finding that screening first-degree relatives will be an effective way to detect glaucoma in a population.     

The epidemiology of medical treatment for glaucoma and ocular hypertension in the United Kingdom: 1994 to 2003

AIMS: To study trends in the prevalence of being treated for glaucoma and ocular hypertension from 1994 to 2003, and to examine factors determining treatment in 2002. METHODS: Computerised data (the DIN-LINK database) from 131 general practices across the United Kingdom, in which half a million patients aged 40 years or more were registered annually, were used. On average 10 000 patients were treated for glaucoma and ocular hypertension annually. RESULTS: Prevalence of being treated for glaucoma and ocular hypertension increased from 1.7% in 1994 to 2.3% in 2003. Those aged 85 years or more were 13 times (95% CI 12.2 to 13.8) more likely to be treated than those aged 40-64 years. Men were more likely to be treated than women (OR 1.24, 95% CI 1.19 to 1.28). Subjects "hard pressed" were less likely to be treated than "wealthy achievers" (OR 0.92, 95% CI 0.86 to 0.99). While use of topical beta blocker only medications has declined since 1995, use of topical prostaglandins and combination therapies has increased. In 2003, use of prostaglandins overtook beta blocker only medications. CONCLUSION: Prevalence of being treated for glaucoma has increased over time, and rises with age. Differences in treatment by sex and social status could be explained by use of or access to health care or by underlying prevalence of disease. Trends in treated glaucoma emphasise the shift from use of topical beta blockers to newer therapies.     

Analysis of risk factors that may be associated with progression from ocular hypertension to primary open angle glaucoma

Background: As a multifactorial disease, glaucoma may be associated with pressure‐dependent and pressure‐independent factors. Ocular hypertension (OHT) may develop into primary open angle glaucoma (POAG) for many patients. Groups with OHT and POAG were compared for pressure‐dependent and independent risk factors. A high prevalence of any factor(s) could indicate a contribution to progression from OHT to POAG. Methods: A sample of patients with POAG (n = 438) and with OHT (n = 301) were selected from those attending a tertiary referral private glaucoma practice, and data were collected regarding age and intraocular pressure at the time of diagnosis, sex, family history of glaucoma, systemic hypertension, diabetes, Raynaud's phenomenon, migraine and myopia. Results: After multivariate analysis, older age at time of diagnosis (χ²₅ = 73.89, P < 0.001), myopia (odds ratio [OR] = 1.5, 95% confidence interval [CI] 1.0?2.2; P < 0.05), a family history of glaucoma (OR = 1.6, 95% CI 1.1?2.3; P < 0.01) and a high intraocular pressure (χ²₄ = 16.96; P = 0.002) were found to be more prevalent among those with POAG. No other significant differences could be found between the two groups. Conclusion: Patients who have OHT may be at higher risk of developing POAG if they also have myopia, a family history of glaucoma or are of older age.     

Prevalence of signs and symptoms of ocular surface disease in individuals treated and not treated with glaucoma medication

Background: To determine the prevalence of signs and symptoms of ocular surface disease in two hospital‐based cohorts; glaucoma patients and non‐glaucoma patients. Design: A cross‐sectional, comparative case series. Participants: Glaucoma patients (n = 300) prescribed topical glaucoma medications for ≥6 months were compared with control patients (n = 100) who were not applying prescribed topical medications. Methods: A validated self‐report questionnaire was used to elicit the extent of ocular symptoms. Signs of ocular surface and eyelid disease were assessed along with medication history. Main Outcome Measures: Signs and symptoms of ocular surface pathology were determined including the tear film break‐up time, fluorescein staining of the cornea and conjunctiva, meibomian gland dysfunction and Schirmer's test. Results: A significant increase in the prevalence of ocular surface disease signs was observed in the glaucoma population, 70.3%, compared with controls, 33% (P < 0.001). The overall prevalence of clinically significant ocular surface disease symptoms was not significantly different between cohorts, 30.7% versus 24.0%, respectively (P = 0.252). Logistic regression analysis showed that the number of anti‐glaucoma medications and duration of therapy were key predictors of significant ocular surface disease signs in the glaucoma group. There was no significant correlation between signs and symptoms of ocular surface disease in either group after adjusting for age and gender. Conclusions: Signs and symptoms of ocular surface disease are relatively common in older patients, but signs of ocular surface disease are significantly higher in individuals who instil topical glaucoma therapy.     

Nutritional,lifestyle and environmental factors in ocular hypertension and primary open‐angle glaucoma: an exploratory case–control study

Purpose: To evaluate known and potential risk factors, including nutritional, lifestyle and environmental factors, differentiating patients with high‐tension primary open‐angle glaucoma (POAG) from control subjects with ocular hypertension (OHT). Methods: In 2006–2007, 111 French ophthalmologists prospectively enrolled 339 cases of POAG and 339 age‐matched controls with OHT. After a clinical examination with assessment of ocular risk factors, the ophthalmologist filled, during face‐to‐face interview, a detailed questionnaire developed by nutritionists and epidemiologist on lifestyle and environmental risk factors, including socio‐demographic variables, dietary habits related to omega‐3 fatty acids intake, smoking and alcohol drinking and professional exposure to pesticides and other chemicals. Associations of POAG with risk factors were estimated using conditional logistic regression, with adjustment for age, gender and duration of disease. Results: In the final multivariate model, by comparison with OHT, POAG was significantly associated with more frequent use of pesticides during the professional life [OR = 2.65, 95% confidence interval (CI): 1.04–6.78, p = 0.04] and with low consumption of fatty fish (OR = 2.14, 95% CI: 1.10–4.17, p = 0.02) and walnuts (OR = 2.02, 95% CI: 1.18–3.47, p = 0.01). POAG was also associated with higher frequency of heavy smoking (40 pack‐years or more, OR = 3.93, 95% CI: 1.12–13.80, p = 0.03) but not with moderate (20–40 pack‐years) and light smoking (<20 pack‐years). Conclusions: These exploratory observations suggest a protective effect of omega‐3 fatty acids and a deleterious effect of heavy smoking and professional exposure to pesticides in POAG. This will need to be confirmed in future studies.     

Relationship between systemic hypertension,perfusion pressure and glaucoma: A comparative study in an adult Indian population

Aims:

To study the relationship between blood pressure (BP), intraocular pressure (IOP), mean ocular perfusion pressure (MOPP) and primary open angle glaucoma (POAG) in patients with hypertension and compare it to a control group of normotensives.

Design:

Cross-sectional observational study.

Materials and Methods:

A total of 108 subjects with primary hypertension and 100 age-matched controls without hypertension were enrolled for the study. IOP measurement using Noncontact Tonometer and dilated fundus evaluation using + 90 D lens were done for all cases. Single recording of BP was taken. Gonioscopy, Humphrey''s central visual fields, optical coherence tomography and pachymetry were done for all subjects with IOP > 21 mm Hg or C: D ratio ≥ 0.5 or asymmetry of > 0.2.

Statistical Analysis:

Univariate and multivariate multinomial regression models were used to determine the association between covariates and risk of glaucoma or glaucoma suspect.

Results:

There was no difference in the glaucoma status between subjects with and without hypertension. Subjects on antihypertensive medications were 1½ times more likely to have suspicious glaucoma (odds ratio [OR] =1.56] and nearly twice as likely to have POAG (OR = 1.85). In addition, we found a 31% and 12% reduction in risk of having POAG (95% confidence interval [CI] =13–45%, P = 0.001) and glaucoma suspect (95% CI = 2–21%, P = 0.03) respectively with every 1 mm Hg increment in MOPP.

Conclusion:

Subjects on antihypertensive medications are more likely to have either glaucoma or glaucoma suspect, and higher ocular perfusion pressure offers relative protection from glaucomatous damage.     

Phaco-Trabeculectomy in Controlled,Advanced, Open-Angle Glaucoma and Cataract: Parallel,Randomized Clinical Study of Efficacy and Safety

Abstract

Background: To examine the efficacy and safety of combined phaco-trabeculectomy in patients with cataract and controlled, open-angle advanced glaucoma and to identify preoperative predictive factors of postoperative glaucoma course. Setting: Departments of Ophthalmology, University of Athens, and General Hospital of Lamia, Greece. Methods: Prospective, interventional, parallel, cluster (units?=?examinations), randomized clinical study. 60 patients with visually significant cataract, visual field Mean Deviation (MD) worse than ?15.0?dB, and preoperative intraocular pressure (IOP), controlled (consistently below 22?mmHg) on topical medications and with no previous ocular surgery, were randomly allocated (1:1) to phacoemulsification alone or phaco-trabeculectomy group. Intention-to-treat analysis was performed to compare the postoperative outcome and adjusted multivariate longitudinal linear regression analysis was performed to identify predictive factors of the main outcome measures, with postoperative visual field MD change up to two years postoperatively. Participant recruiters and data collectors were masked to group assignment. Results: 31 and 29 patients were randomized to phacoemulsification alone and phaco-trabeculectomy groups, respectively. Patients assigned to the phaco-trabeculectomy group experienced a 1.7?mmHg [95% CI:?3.1 to ?0.23] reduction in IOP, a 1.4?dB [95% CI: ?0.17 to 2.96] improvement in visual fields MD, a 0.6 [95% CI: ?1.2 to ?0.05] reduction in the number of glaucoma medications needed postoperatively, while the visual acuity improvement was similar between the two groups. Best predictors for visual field MD: degree of nuclear sclerosis, relative afferent pupilary defect (RAPD), preoperative MD deviation from ?19.0dB and preoperative cup-disc ratio deviation from 0.9. The phacoemulsification group experienced more IOP spikes (>25?mmHg) with Odds Ratio (OR) of 0.34 [95% CI: 0.11–1.02]. No patient lost light perception. Conclusion: Phaco-trabeculectomy in advanced, controlled, open-angle glaucoma patients with cataract results in better postoperative visual field MD with no major adverse events.     

Prevalence of Pseudoexfoliation Syndrome Among Adult Spanish in the Salnés eye Study

Purpose: To estimate the prevalence of Pseudoexfoliation syndrome (PXF) and to investigate its relationship with systemic and ocular diseases and lifestyle factors in a general adult population in north-western Spain.

Methods: An age-stratified random sample of 1155 subjects was drawn from the population aged 40 years and over of O Salnés (Spain). From 937 eligible subjects, 619 (66.1%) participated (mean age (Standard Deviation [SD]): 63.4 (14.5) years, range: 40–96, 37.0% males). An interview to collect past history of ocular and systemic diseases and lifestyle details, and a comprehensive ophthalmic evaluation were performed. Study subjects with typical pseudoexfoliative material on the anterior capsule or in the pupil margin were labelled as having PXF. A design based analysis was performed and all calculations were weighted to give unbiased estimates.

Results: The prevalence of PXF was 6.5% (95% confidence interval [CI]:4.9–8.1). PXF rates increased significantly with age (P?=?0.000). No cases of PXF were detected in subjects between 40 and 60 years. Prevalence of PXF was 8.0% (95% C I5.4–11.6) in men and 5.4% (95% CI 3.8–7.6) in women (P?=?ns). The prevalence of glaucoma in subjects with PXF was 19.6% (95% CI 8.2–40.0). After controlling for age and sex, glaucoma, cataract surgery, rose bengal staining and diabetes were associated with PXF but only glaucoma and rose bengal staining associations remained significant in a multivariate model.

Conclusions: PXF is common among older individuals in north-western Spain. Subjects with pseudoexfoliation have a significantly higher prevalence of glaucoma than subjects without. An abnormal ocular surface detected by rose bengal staining is highly prevalent among subjects with pseudoexfoliation.     

Association between Exposure to Smartphones and Ocular Health in Adolescents

Purpose: Smartphone use has dramatically increased in recent years. Smartphones may have adverse health effects, particularly on the eyes, because users stare at the screen for a much longer time than they do with ordinary mobile phones. The objective of this study was to elucidate the relationship between smartphone use and ocular symptoms among adolescents.

Methods: Information on smartphone use and ocular symptoms (blurring, redness, visual disturbance, secretion, inflammation, lacrimation and dryness) related to eye fatigue and strain from 715 adolescent subjects from three cities in Korea was obtained using a structured questionnaire. Ocular health was scored using number of ocular symptoms. Odds ratios (ORs), 95% confidence intervals (95% CIs) and p-values for ocular symptoms were calculated with binomial and multinomial logistic regression models.

Results: Higher prevalence rates for ocular symptoms were observed in groups with greater exposure to smartphones (p < 0.05). Longer daily smartphone use was associated with a higher likelihood of having multiple ocular symptoms (5–7 symptoms out of 7 symptoms; p = 0.005). Excessive/intermittent use (>2 hours daily and ≤2 hours continuously) and excessive/persistent use (>2 hours daily and >2 hours continuously) compared to shorter use (<2 hours daily) were associated with multiple ocular symptoms (OR 2.18, 95% CI 1.09–4.39; OR 2.26, 95% CI 1.11–4.57, respectively). A higher lifetime exposure to smartphones was associated with a higher likelihood of having multiple ocular symptoms (OR 3.05, 95% CI 1.51–6.19; p = 0.001).

Conclusion: Increasing exposure to smartphones can have a negative impact on ocular health in adolescents.     

Glaucoma after ocular contusion: a cohort study of the United States Eye Injury Registry

PURPOSE: This cohort study was designed to evaluate risk factors for the development of posttraumatic glaucoma after ocular contusion. METHODS: Data from the United States Eye Injury Registry (USEIR) were obtained from a total of 6021 patients who experienced blunt ocular contusion. Logistic regression was used to evaluate the association between these baseline structural and functional ocular characteristics and posttraumatic glaucoma. Odds ratios with 95% confidence intervals were obtained. RESULTS: The 6-month incidence of developing posttraumatic glaucoma was 3.39%. The development of glaucoma was independently associated with: advancing age (OR = 1.02; 95% CI = 1.02, 1.03), visual acuity worse than 20/200 (OR = 1.92; 95% CI = 1.19, 3.10), iris injury (OR = 1.60; 95% CI = 1.05, 2.44), lens injury (OR = 1.86; 95% CI = 1.11, 3.11), hyphema (OR = 2.23; 95% CI = 1.40, 3.54), or angle recession (OR = 1.71; 95% CI = 1.00, 2.90). CONCLUSION: This study provides an estimate for the risk of developing glaucoma after ocular contusion in a large cohort of patients and has determined several independently predictive factors that were significantly associated with the development of posttraumatic glaucoma including poor initial visual acuity, advancing age, lens injury, angle recession, and hyphema.     

Evaluation of an eye drop guide to aid self-administration by patients experienced with topical use of glaucoma medication

BACKGROUND: Methods to improve patient compliance with prescribed topical use of glaucoma medication are sorely needed. A guide for the topical administration of ocular medication was suggested as such a tool. We investigated whether eye drop self-administration would be improved with use of the guide. METHODS: An eye drop guide, a funnel-shaped device designed to fit within the contour of the orbital margins, was offered to 114 patients for use at home with their glaucoma medication. A questionnaire asking about the ease of eye drop self-administration was administered before and after 1 week's use of the device. RESULTS: Of the 111 patients who accepted the guide, 93 returned a usable completed questionnaire. Seventy-four percent said that they found it easier to administer their eye drops without the guide and preferred to do so (chi2 = 21.77, p < 0.01). Patients using more doses per day found it more difficult to administer their drops using the guide (r = -0.233, p < 0.05), and those who had been using drops longer preferred not to continue using the guide (r = -0.222, p < 0.05). Patients who found the written instructions clearer found it easier to administer their drops using the guide (r = 0.329, p < 0.05). INTERPRETATION: Although intended to ease the administration of eye drops, the guide proved to be counterproductive. Further work is necessary to investigate other methods of improving patient compliance with prescribed topical use of ocular medications.     

A National Survey of Glaucoma Specialists on the Preoperative (Trabeculectomy) Management of the Ocular Surface*

Background: Preserved anti-glaucoma drops cause ocular surface disease (OSD), which is increasingly being recognized as a likely cause of trabeculectomy failure. Aim: To determine the routine pre-trabeculectomy management of the ocular surface by glaucoma specialists. Methods: A questionnaire consisting of 11 questions was posted to 146 UK glaucoma specialists. Results: The first-time response rate was 43.8%. Regarding routine pre-operative management, 40.6% of specialists use preservative-free drops, 29.7% commence a drop holiday, and 53% advise lid hygiene. 42.1% prescribe lubricants, 50% prescribe topical steroids, 7.8% topical NSAIDs, and 34.4% systemic tetracyclines. 84.4% of specialists change their routine management if OSD is present. Pre-operative optimization of the ocular surface is viewed “necessary” by 48.4% and “beneficial” by 85.9%. Conclusion: A wide variation exists in the routine pre-operative management of the ocular surface. Research to determine the impact of different pre-operative interventions upon trabeculectomy outcomes is required.     

Profile of ocular conditions from school eye screening in Southern India

Purpose:To profile the presentation of ocular conditions among school children aged 6 to 17 years from the south Indian state of Tamil Nadu.Methods:The study was conducted as part of a school eye health program in Kanchipuram district, Tamil Nadu that aimed to address the refractive needs of children (6–17 years) between July 2016 and June 2019. The study followed a three-phase protocol, which included visual acuity test, modified clinical test, color vision test, binocular vision assessment, objective and subjective refraction, dispensing spectacles, posterior segment evaluation using direct ophthalmoscopy, and referral to the base hospital. The demographics, clinical details, and ocular conditions (classified under 16 categories) were analyzed. Profiling and association of ocular conditions among different locations, types of schools, class grades, and gender were presented.Results:Data of 2,45,565 children were analyzed from 1,047 schools, of which 4,816 (1.96%) children were identified with ocular conditions other than refractive errors. The common reasons for referral were high myopia 901 (0.37%), strabismus 819 (0.33%), and amblyopia 691 (0.28%). Retinal problems (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.22–2.22, P = 0.001) and strabismus (OR: 1.41, 95% CI: 1.21–1.65, P < 0.001) were the conditions prevalent in the rural location. Cataract and related conditions (OR: 5.73, 95% CI: 4.10–8.01, P < 0.001) and retinal problems (OR: 4.76, 95% CI: 3.37–6.72, P < 0.001) were common in children studying in public schools. Of the 16 categories, 13 conditions were seen among primary school children. Vernal keratoconjunctivitis (OR: 3.64 95% CI: 2.12–6.23 P < 0.001) was common among males.Conclusion:The study profiled ocular conditions among school children. Most ocular conditions warrant prolonged care and specialty eye care services. Ensuring the availability of such services and follow-up after school eye screening would safeguard the visual development of these children.     

Goldmann tonometry and pachymetry measures in patients with and without topical medical treatment at a glaucoma clinic

Purpose: To investigate, by audit, the intraocular pressure (IOP) and central corneal thickness (CCT) of patients attending a routine glaucoma clinic, in order to assess the potential effect of CCT on IOP measures. Methods: Data on current IOP (Goldmann), CCT (ultrasound) and glaucoma medications use were collected from 140 patients who presented for a follow‐up visit over a 3‐month period. Baseline IOP was retrieved from patient records. Results: The IOP was lower at follow‐up, an expected effect of the use of IOP‐lowering medications. However, the CCT was lower in medicated patients indicating, but not proving, that it changed in response to the lowering of IOP. Overall, the measured IOP was higher in patients with greater CCT values (p < 0.001) but this IOP–CCT relationship was most noticeable in patients with normal tension glaucoma and not obvious in those diagnosed with ocular hypertension. Overall, the slope of the IOP–CCT relationship was slightly steeper for those patients prescribed glaucoma medications. Conclusions: In the routine assessment of glaucoma patients, corneal thickness can be shown to have an impact on applanation tonometry data. However, this effect may not be uniformly evident in patients with different types of glaucoma and may be different for patients under topical medical treatment.     

Is glaucoma associated with motor vehicle collision involvement and driving avoidance?

PURPOSE: To evaluate the association between the diagnosis of glaucoma and motor vehicle collision (MVC) involvement and driving avoidance in drivers aged > or =50 years. METHODS: Two groups of patients, one with glaucoma and one without, were identified in three university-affiliated eye care practices. Demographic, clinical, and driving characteristics were obtained by chart abstractions and a patient survey. Information regarding MVC involvement was obtained from police records. RESULTS: Patients with glaucoma were less likely (relative risk [RR], 0.67; 95% confidence interval [CI], 0.47-0.97) to be involved in collisions than patients without glaucoma. There was no difference between the at-fault crash rates of the patients with glaucoma and those without (RR, 1.22; 95% CI, 0.67-2.22). Patients with glaucoma had significantly higher levels of avoidance for driving at night (odds ratio [OR], 2.06; 95% CI, 1.11-3.82), driving in fog (OR, 3.80; 95% CI, 1.93-7.48), driving in the rain (OR, 2.99; 95% CI, 1.32-6.76), driving during rush hour (OR, 2.24; 95% CI, 1.16-4.34), driving on the highway (OR, 2.81; 95% CI, 1.19-6.64), and high density driving (OR, 2.88; 95% CI, 1.28-6.46). These associations were adjusted for demographic and medical characteristics as well as visual acuity. CONCLUSIONS: Older persons with glaucoma drive at least as safely as, if not more safely than, older persons without glaucoma.     

曲伏前列素滴眼液治疗原发性开角型青光眼和高眼压症

目的：研究曲伏前列素滴眼液治疗原发性开角型青光眼和高眼压症的降眼压效果及安全性。方法：随机选取2013-03/2016-03我院收治的原发性开角型青光眼和高眼压症患者80例80眼,依据不同治疗方法分为两组：曲伏前列素滴眼液组( n=40)和拉坦前列素滴眼液组(n=40),对两组患者的临床疗效、视力、散光度、眼压及不良反应发生情况进行统计分析。结果：曲伏前列素滴眼液组患者治疗的总有效率95%(38/40)显著高于拉坦前列素滴眼液组80%(32/40),差异有统计学意义(P<0.05)。曲伏前列素滴眼液组患者治疗后视力显著高于拉坦前列素滴眼液组,差异有统计学意义(P<0.05),散光度、眼压均显著低于拉坦前列素滴眼液组,差异有统计学意义(P<0.05),不良反应发生率25%(10/40)显著低于拉坦前列素滴眼液组53%(21/40),差异有统计学意义(P<0.05)。结论：曲伏前列素滴眼液治疗原发性开角型青光眼和高眼压症比拉坦前列素滴眼液具有较好的降眼压效果及较高的安全性。     

选择性激光小梁成形术与抗青光眼药物治疗青光眼和高眼压症疗效的Meta分析

背景 选择性激光小梁成形术(SLT)和抗青光眼药物均可用于青光眼或高眼压症(OHT)的治疗,但目前还缺乏比较两种治疗方法的疗效和安全性的循证医学证据. 目的 评价和比较SLT与抗青光眼药物治疗青光眼及OHT的疗效和安全性. 方法 利用计算机检索Pubmed、Embase、Cochrane Controlled Trials Register database、万方数据库2016年5月前发表的关于比较SLT与抗青光眼药物治疗青光眼及OHT疗效的随机对照研究的文献,采用Revman 5.3软件进行Meta分析,疗效评价指标包括眼压下降幅度值(IOPR)和治疗成功率,安全性评价指标包括治疗的不良反应.采用加权均数差值(WMD)分析IOPR,采用比值比(OR)分析随访期间的治疗成功率.结果 纳入6项随机临床对照试验,样本量共361例598眼(高加索人243眼,亚裔291眼,其他人种64眼),研究对象均为青光眼或OHT患者,其中5项研究(431眼)比较了SLT与抗青光眼药物治疗后的IOPR,药物组患者IOPR比SLT组多0.21 mmHg(1 mmHg=0.133 kPa),差异有统计学意义[WMD=-0.21 mmHg;95％置信区间(CI):-0.30,-0.11;P＜0.000 1],各研究间无异质性(I2=0％).纳入的6项研究均比较了2种治疗方法的成功率,药物组成功率高于SLT组,差异有统计学意义(OR=0.57;95％ CI:0.37 ～0.87;P=0.01),各研究间无异质性(I2=13％). 结论 抗青光眼药物和SLT疗法对青光眼和OHT患者均有降眼压作用,但抗青光眼药物的降眼压效果优于SLT.     

Examination of First-Degree Relatives of Patients With Glaucoma: A Randomized Trial of Strategies to Increase Use in an Eye Hospital in Africa

Objective: To determine the best approach to examine first-degree relatives (FDR) of glaucoma patients in a rural African setting. Methods: Randomized controlled trial of FDR aged 40 years and older of (index) open angle glaucoma patients who presented to KCMC Hospital. Two strategies of uptake were tested. The main outcome measure was FDR presentation for examination for glaucoma. Results: From 182 index cases, 484 FDR were enrolled in the study, 256 randomized to free examination, and 228 randomized to standard (pay) examination. Overall, 8.1% (95% CI: 5.7–10.5) came for examination. FDR who were offered examination free of charge were 1.87 times (95% CI: 0.94–3.73) more likely to present than those offered standard examination. Among those offered free examination, living near the hospital was associated with presentation (OR = 2.85; 95% CI: 1.10–7.36) whereas among those offered standard examination the association with residence was weak (OR = 2.27; 95% CI: 0.72–7.15). Conclusions: Providing good quality counseling of index cases and offering glaucoma examination free of charge is not sufficient to reach those at risk of glaucoma, suggesting that the indirect costs of accessing services are significant barriers to use of examination services. Other means of encouraging FDR to come for glaucoma examination should be investigated.